muscular sarcoidosis

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a chronic, progressive, generalized granulomatous reticulosis that may affect any part of the body but most frequently involves the lymph nodes, liver, spleen, lungs, skin, eyes, and small bones of the hands and feet, characterized by the presence in all affected organs or tissues of epithelioid cell tubercles, which become converted, in the older lesions, into a rather hyaline featureless fibrous tissue.

As there is no specific test for sarcoidosis, diagnosis is based on clinical examination, x-rays, fiberoptic bronchoscopy, gallium-67 scan, serum angiotensin-converting enzyme, and a skin test called the Kveim test.

Blood studies may reveal blood dyscrasias such as anemia, leukopenia, eosinophilia, hypergammaglobulinemia, and a reduction in serum albumin. In a small percentage of patients there may be a transient hypercalcemia and hypercalciuria in the early stages of the disease. Patients have a delayed skin reactivity to tuberculin and other antigens such as candidiasis and mumps.
Patient Care. Sarcoidosis is a multisystem disease that can cause complex problems for those who have an active case. However, some patients are asymptomatic and have pulmonary function within normal limits, so that no treatment is required. For patients who do have impaired lung function with pulmonary infiltrates, adrenal corticosteroids are prescribed, often for an extended period of time.

Patients are encouraged to keep appointments for follow-up medical evaluations. For self-monitoring they are taught symptoms to report such as shortness of breath, excessive tearing and inflamed eyes, chest pain, swollen joints, and an increased sense of being tired and listless. An irregular pulse rate or one that is under 50 or over 120 beats per minute should also be reported. Persons who do not know how to take their own pulse are taught how to do it. Periodic ophthalmologic examinations are imperative because of the possibility that sarcoidosis can affect the eye and cause uveitis, iritis, glaucoma, and cataracts.

Those receiving steroid therapy are taught the use and side effects of their medication. They are cautioned not to stop taking the prescribed drug, because this can produce a drop in blood pressure with fever, nausea, vomiting, and diarrhea.

Smoking is harmful because it aggravates impaired lung function; hence patients are encouraged to seek help if they need to quit smoking. Prolonged exposure to direct sunlight should be avoided because vitamin D aids absorption of calcium, which can contribute to elevated serum and urinary calcium levels and the formation of kidney stones. Well-informed patients can contribute a great deal to the management of their disease and enhance their sense of self-esteem and control, as well as avoid serious complications.
Sarcoidosis. The most common sites of granulomas are the lungs and thoracic lymph nodes. Other extrathoracic sites are less commonly involved. Also shown is a granuloma composed primarily of epithelioid cells, macrophages, and lymphocytes. From Damjanov, 2000.
cardiac sarcoidosis involvement of the heart in sarcoidosis, with lesions ranging from a few asymptomatic granulomas to widespread infiltration of the myocardium by large masses of sarcoid tissue; it is characterized by a high incidence of atrioventricular block as well as right bundle branch block and ventricular arrhythmias.
muscular sarcoidosis sarcoidosis involving the skeletal muscles, with sarcoid tubercles, interstitial inflammation with fibrosis, and disruption and atrophy of the muscle fibers.

muscular sarcoidosis

the formation of epithelioid tubercles in the skeletal muscles, characterized by interstitial inflammation, fibrosis, atrophy, and damage to the muscle fibers as the tubercles form within and replace normal muscle cells. See also sarcoidosis.